PRIMARY OBJECTIVE:This paper reports on the personal experiences of loneliness for individuals living with brain injury.RESEARCH DESIGN:This is a qualitative research design, employing semi-structured interviews and subsequent contextualist thematic analysis.METHODS AND PROCEDURES:Eleven clients (two female and nine male, aged between 27 and 63 years) with brain injury participated in semi-structured interviews. Thematic analysis was employed in the interpretation of the data.MAIN OUTCOMES AND RESULTS:The interview data and subsequent analysis depicted three overarching themes in a healing process - 'Internal Loneliness', 'Healing the Cracks', and 'Visible with Cracks'. Participants described five factors which contribute to their feeling of loneliness: trauma, social isolation, concealment, rejection of part of self, and invisibility of their disability. The participants' accounts also detailed the necessity of a therapeutic intervention and relationship to deal with and address some of these issues.CONCLUSIONS:This study highlights that processing the trauma, developing dialectical thinking, self-compassion, and a degree of self-acceptance assist in the movement of participants towards allowing themselves to be 'Visible with Cracks'. This allowance of self to be fully seen appears to serve an important function for reconnection with self and others. These results may help to inform brain injury rehabilitative care, through developing their understanding of the internal loneliness factors that may be influencing an individual's social isolation or social withdrawal.

Abstract Background Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, little data exists on the number of TBI survivors or the availability of brain injury rehabilitation services. To address this, we examined nationally representative data to estimate the number of moderate to severe TBI survivors and to learn of their rehabilitation experiences. Methods A two-year mixed-methods, observational, cohort study was used to investigate the rehabilitation pathways of moderate to severe TBI survivors (N = 120). Participants were surveyed on two occasions six months apart using a range of standardised instruments (EQ-5D-3L, WHOQOL BREF and EBIQ). Preliminary findings from first surveys are reported. Results Fifty percent of participants reported having received some rehabilitation during their initial hospitalization. Following discharge, inpatient rehabilitation was recommended in 55.8% of cases (N = 67); 62.5% (N = 75) in an outpatient setting and 52.1% (N = 62) in a specialised brain injury community-based setting. Rehabilitation was not recommended in 9.2% (N = 11) of cases. Univariant analyses showed statistically significant differences between the experiences of males (N = 87) and females (N = 33) in three main elements; Isolation: males (M), mean 1.88, SD .488, females (F) mean 1.64, SD .476, (p = .015); Communication: M mean 1.85, SD .565, F mean 1.57, SD .469 (p = .012); Cognitive difficulties: M mean 1.81, SD .456, F mean 1.59, SD .426 (p = .020). Discussion Referrals to rehabilitation services varied substantially in this cohort of TBI survivors with evidence to suggest that, overall, males experience greater impacts on quality of life than do females. These findings support the need to, a) increase political priority and resource allocation for rehabilitation services for TBI survivors in Ireland and b) further study gender differences in TBI survivor outcome. Key messages Survivors of moderate to severe brain injury in Ireland have very divergent, and often inadequate experiences of rehabilitation. There is some evidence that male survivors of moderate to severe traumatic brain injury face more challenges than do female survivors.

There is a gap in the literature concerning the efficacy versus effectiveness of Cognitive Behavioral Therapy (CBT) for Acquired Brain Injury (ABI). Effectiveness relates to how treatments work in practice. Efficacy measures how they work in clinical trials with stringent inclusion and exclusion criteria. We assessed treatment in a regular clinic setting to determine effectiveness of CBT as it is usually delivered. This study audits the effectiveness of CBT in a real-world setting rather than efficacy.

Objective: Conduct a scoping review of literature surrounding acquired brain injury (ABI) sustained secondary to a suicide attempt to establish the current body of research on injury outcomes and rehabilitative needs for this population. Methods: A systematic search of the literature was conducted. Searches were conducted using terms relating to this injury etiology and search results with original or secondary data on individuals with an ABI were included for review. Results: Thirty-two articles were reviewed. Limited data characterizing this population exists in the literature. Findings indicate that this population have generally poorer injury outcomes compared with ABI sustained through other means. Rehabilitative needs are rarely addressed, but limited commentary suggests that extensive pre-morbid conditions, severity of injuries and psychosocial support needs of this population present implications for rehabilitative supports. Conclusion: There is a relative dearth of research examining ABI sustained secondary to a suicide attempt. Collated findings suggest these individuals are rarely recognized in the literature as a distinct ABI population with rehabilitative needs specific to this etiology. Future research should aim to address the gaps identified in the literature, including characterizing the population, establishing pre-morbid conditions and developing tailored rehabilitative support to address complex needs.

Post-acute community-based rehabilitation is effective in reducing disability. However, while social participation and quality of life are valued as distal outcomes of neurorehabilitation, it is often not possible to observe improvements on these outcomes within the limited time-frames used in most investigations of rehabilitation. The aim of the current study was to examine differences in the sequence of attainments for people with acquired brain injury (ABI) undergoing longer term post-acute neurorehabilitation. Participants with ABI who were referred to comprehensive home and community-based neurorehabilitation were assessed at induction to service, at 6 months and again at 1.5 years while still in service on the Mayo-Portland Adaptability Index (MPAI-4), Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and World Health Organisation Quality of Life measure. At 6 months post-induction to service, significant differences were evident in MPAI abilities, adjustment, and total neurodisability; and in anxiety and depression. By contrast, there was no significant effect at 6 months on more socially oriented features of experience namely quality of life (QoL), Community Integration and Participation. Eighteen month follow-up showed continuation of the significant positive effects with the addition of QoL-related to physical health, Psychological health, Social aspects of QoL and Participation at this later time point. Regression analyses demonstrated that change in QoL and Participation were dependent upon prior changes in aspects of neurodisability. Age, severity or type of brain injury did not significantly affect outcome. Results suggest that different constructs may respond to neurorehabilitation at different time points in a dose effect manner, and that change in social aspects of experience may be dependent upon the specific nature of prior neurorehabilitation attainments.

Primary objective: The present study aimed to investigate the specific ways in which individuals reconstruct their sense of self following injury to the nervous system, by comparing individuals with acquired brain injury (ABI) and individuals with spinal cord injury (SCI), two groups that have experienced a sudden-onset injury with life-changing repercussions. Research design: Phenomenological qualitative research. Methods and procedures: Nine individuals with ABI and 10 individuals with SCI took part in an interview exploring the ways in which individuals reconstruct their sense of self following injury. Data were analysed using interpretative thematic analysis. Main outcomes and results: Findings showed similar themes identified within the interview data of the ABI and SCI groups. Both groups developed positive and negative self-narratives. Individuals employed strategies that facilitated the reconstruction of positive self-narratives. In addition, individuals described their sense of self as simultaneously continuous and changing. Discussion: Findings are discussed in relation to proposed models of self-reconstruction post-injury to the nervous system.

Prospective memory (PM), persisting and disabling problem following acquired brain injury (ABI). It is widely accepted that compensatory strategies are the treatment of choice in the rehabilitation of PM deficits. The advent of new technologies has broadened the array of external memory aids to include potentially useful personal digital assistants (PDAs) in alleviating PM deficits. This study aimed to investigate the effectiveness of an unmodified off-the-shelf PDA (Palm IIIe®) in compensating for everyday PM problems. Five participants with ABI were trained to programme the PDA to prompt them with an audible cue and on-screen message at appropriate times. Seven personally relevant PM tasks were set up weekly to measure the usefulness of the PDA as compared to relying on memory alone. An A-B quasi-experimental design was employed which consisted of two phases: the A (memory only) baseline phase and the B (PDA strategy) intervention phase. Task performance was compared between phases A and B. All participants performed significantly better during the two weeks in which they used the PDA (Z = –2.02, p<0.05) demonstrating its efficacy in reducing PM failures. The limitations of the PDA and a range of possible solutions to improve its efficiency are discussed including strategies around delayed-execute PM tasks.

This paper reviews treatment outcome studies on cognitive behavioural therapy (CBT) for depression and anxiety following acquired brain injury (ABI), including traumatic brain injury (TBI), cerebral vascular accident (CVA), anoxia and neurosurgery. Studies are included for review when the published paper included an anxiety disorder or depression as the treatment focus, or as part of outcome measurement. Relaxed criteria were used to select studies including relevant single-cases, case series and single group studies along with studies that employed control groups. Twenty-four studies were identified. Twelve papers were of a single-case design (with or without replication). Two papers used uncontrolled single groups and ten studies used a control group. There were a total of 507 people in the various treatment and control groups, which ranged in size from 6 to 67 persons. All participants in the study had an ABI. Our review indicates CBT often shows a within-group pre- to post-treatment statistical difference for depression and anxiety problems, or a statistical difference between CBT-treated and non-treated groups. For studies that targeted the treatment of depression with CBT, effect-sizes ranged from 0 to 2.39 with an average effect-size of 1.15 for depression (large effect). For studies that targeted the treatment of anxiety with CBT, effect-sizes ranged from 0 to 3.47 with an average effect-size of 1.04 for anxiety (large effect). However, it was not possible to submit all twenty-four studies identified to effect-size analysis. Additionally, it is clear that CBT is not a panacea, as studies frequently indicate only partial reduction in anxiety and depression symptoms. This review suggests that if CBT is aimed at, for example, anger management or coping, it can be effective for anger or coping, but will not generalise to have an effect on anxiety or depression. CBT interventions that target anxiety and depression specifically appear to generate better therapeutic effects on anxiety and depression. Gaps in the literature are highlighted with suggestions for future research.

In a comparative group outcome study involving 40 parents of children with disruptive behaviour disorders, it was found that compared with controls, those who participated in the Parenting Plus Programme reported greater gains in the attainment of personal parenting goals. Also, there were trends for participants in the Parenting Plus Programme to report fewer child behaviour problems on the externalizing scale of the Child Behaviour Checklist (CBCL) and the total problems, conduct problems and hyperactivity scales of the Strengths and Difficulties Questionnaire (SDQ). In addition, compared with controls, parents who participated in the Programme reported significant improvements in parent-child interaction on the Parenting Stress Index. Gains on the Parent Goals Scales, the total problem scale ofthe SDQ and the externalizing scale of the CBCL were maintained at 5.5 months follow-up. With respect to clinical significance, compared with controls, twice as many parents who participated in the Parenting Plus...

The Symptom Checklist 90 Revised (SCL-90-R) was used to assign participants to either a good adjustment group or a poor adjustment group. Group differences were analyzed with χ2, t-tests and correlations on factors shown in previous research to be related to coping with spinal cord injury (SCI). This study examines health locus of control (HLC) and attributions of cause and blame in relation to SCI. The replication of study findings in multiple settings is a cornerstone of the evidence base for developing interventions. Previous studies do not show a consensus on the role of attributions of cause and blame in persons with SCI. Similarly, their relationship to adjustment after SCI is unclear. Another attribution, HLC, is similarly analyzed in relation to adjustment. Republic of Ireland. Thirty people with SCI participated. They rated scales measuring psychological adjustment, locus of control (LOC) for health and attributions of cause and blame for the injury. The well-adjusted group had a less external HLC. In addition, participants who were well adjusted endorsed the notion they could have avoided their accident significantly more than the poorly adjusted group. Similarly, they rated the belief that they could have caused the accident at a somewhat greater level. They did not, however, blame themselves any more or any less. Results are consistent with general LOC theory, and suggest an adaptive or protective internal LOC for accepting responsibility for the injury.

This study evaluated the factor structures of three instruments from the Sexual Offender Assessment Pack. The Children and Sex Cognitive Distortions Scale, the Children and Sex Emotional Congruence Scale, and the Child Victim Empathy Distortions Scale were administered to 203 sex offenders in Ireland. Confirmatory factor analyses did not support the proposed single factor structure for each of the three scales. Exploratory factor analyses suggested more complex factor structures. The Children and Sex Cognitive Distortions Scale was found to have two factors: (a) Perceptions of Children as Sexually Mature and (b) General Justifications for Sex With Children. The Children and Sex Emotional Congruence Scale was found to have three factors: (a) Positive Affect From Children, (b) Special Relationships With Children and (c) Preference for Relationships With Children. The Victim Empathy Scale was found to have two factors: (a) Positive Misattributions of Pleasure and (b) Denial of Negative Feelings in the Child. In clinical settings, the more complex factor structures identified in this study may used in scoring and interpreting responses to the three instruments investigated here. Our results require replication and further research should focus on the correlates of the factorial scales identified in this study.